coaching doctors in ethical decision-making (code)

Conditions: End of Life; Interdisciplinary Communication; Leadership

Summary: over the last few decades the fast technical and medical progress poses a significant challenge to doctors, who are asked to find the right balance between life-prolonging and palliative care. previous studies suggest that doctors (unconsciously) prefer to remain prognostically uncertain rather than to gather the information that is required to reduce uncertainty and to effectively timely take decisions in the team for the benefit of the patient. to obtain all that information, the doctor in charge of the patient needs to empower clinicians to speak up while guarantying a safe environment. however, creating a safe climate which enhances inter-professional shared decision-making for the benefit of the patient requires specific self-reflective and empowering leadership skills (including the management of group dynamics in the interdisciplinary team). the aim of this study is to investigate whether coaching doctors in self-reflective and empowering leadership, and in the management of team dynamics with regard to adult hospitalized patients potentially receiving excessive treatment during 4 months 1) improves ethical decision-making (primary objective) and 2) reduces the burden on patients, relatives, clinicians and the society (secondary objective). the improvement in quality of ethical decision-making will be assessed objectively via the incidence of written do-not-intubate and -resuscitate orders (first primary endpoint) in patients potentially receiving excessive treatment and subjectively via the ethical decision-making climate questionnaire that will be filled out by the team (second primary endpoint). in line with the dispropricus study, patients potentially receiving excessive treatment will be defined as patients who are perceived as receiving excessive treatment by two or more different clinicians in charge of the patient. the probability of being alive, at home with a good quality of life one year after admission was only 7% in patients potentially receiving excessive treatment in this study. therefore, perceptions of excessive treatment by two or more clinicians are used in this study as a signal to initiate (self-)reflection in team about the quality of care that is provided to the patient and whether the treatment is in balance with the medical condition of the patient and the patient's goal of care .


Eligibility criteria:
inclusion criteria 1. clinicians' level : doctors (including department head) and nurses (including head nurses) taking care of adult hospitalized patients in the 10 participating departments 2. patients' level : first hospitalization of adult patients who are potentially receiving excessive treatment. 3. family level : family of adult patients who are potentially receiving excessive treatment exclusion criteria : 1. clinicians'level : no exclusion criteria 2. patients' level : patients who cannot understand dutch questionnaires 3. family : persons who cannot understand dutch questionnaires

Keywords: treatment limitation decisions interdisciplinary collaboration coaching self-reflective and empowering leadership ethical climate prognostic uncertainty